超声引导下经肌肉腰方肌阻滞降低全髋关节置换术患者术后疼痛强度：一项随机、双盲、安慰剂对照试验

Ultrasound-Guided Transmuscular Quadratus Lumborum Block Reduces Postoperative Pain Intensity in Patients Undergoing Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial.

作者信息

He Jian, Zhang Lei, He Wan You, Li Dong Lin, Zheng Xue Qin, Liu Qi Xia, Wang Han Bin

机构信息

Department of Anesthesiology, The First People's Hospital of Foshan, Foshan City, China.

出版信息

Pain Res Manag. 2020 Mar 7;2020:1035182. doi: 10.1155/2020/1035182. eCollection 2020.

DOI:10.1155/2020/1035182

PMID:32256907

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7085398/

Abstract

METHODS

Eighty-eight patients undergoing THA were randomized to receive 0.33% ropivacaine (Group QLB, = 44) or saline (Group Con, = 44) for QL3 block. Spinal anesthesia was then performed. Pain intensity was assessed using the visual analog scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on standing and walking at 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, the 10-meter walking speed on day 6, and patient satisfaction after surgery.

RESULTS

Postoperative pain intensity was significantly lower in Group QLB compared to Group Con at rest after 3, 6, 12, 24, 36, and 48 h ( < 0.001) and during mobilization after 24, 36, and 48 h ( < 0.001). Morphine use was significantly lower in Group QLB compared to Group Con during 0-24 h (16.0 ± 7.1 vs. 34.1 ± 7.1 mg, < 0.001) and during 24-48 h (13.0 ± 4.0 vs. 17.4 ± 4.6 mg, < 0.001) postoperatively. The 10-meter walking speed was higher in Group QLB compared to Group Con, both at comfortable (0.79 ± 0.13 vs. 0.70 ± 0.14 m/s, =0.012) and at maximum speeds (1.18 ± 0.26 vs. 1.06 ± 0.22 m/s, < 0.001). Incidences of nausea (7.3% vs. 31%, =0.006), vomiting (7.3% vs. 26.2%, = 0.022), and urinary retention (9.8% vs. 28.6%, =0.030) were lower in Group QLB than in Group Con.

CONCLUSIONS

Ultrasound-guided QL3 block is an effective pain management technique after THA.

摘要

方法

88例行全髋关节置换术（THA）的患者被随机分为两组，分别接受0.33%罗哌卡因（QLB组，n = 44）或生理盐水（Con组，n = 44）进行腰方肌3（QL3）阻滞。随后实施脊髓麻醉。使用视觉模拟量表（0：无痛至10：最剧烈疼痛）评估疼痛强度。主要结局指标为术后3、6、12、24、36和48小时静息时以及24、36和48小时站立及行走时记录的疼痛评分。次要结局指标为镇痛药物消耗量、副作用、术后第6天的10米步行速度以及患者术后满意度。

结果

与Con组相比，QLB组术后3、6、12、24、36和48小时静息时（P < 0.001）以及24、36和48小时活动时（P < 0.001）的疼痛强度显著更低。术后0至24小时（16.0 ± 7.1 vs. 34.1 ± 7.1 mg，P < 0.001）和24至48小时（13.0 ± 4.0 vs. 17.4 ± 4.6 mg，P < 0.001），QLB组的吗啡使用量显著低于Con组。QLB组在舒适速度（0.79 ± 0.13 vs. 0.70 ± 0.14 m/s，P = 0.012）和最大速度（1.18 ± 0.26 vs. 1.06 ± 0.22 m/s，P < 0.001）下的10米步行速度均高于Con组。QLB组恶心（7.3% vs. 31%，P = 0.006）、呕吐（7.3% vs. 26.2%，P = 0.022）和尿潴留（9.8% vs. 28.6%，P = 0.030）的发生率低于Con组。